Harvey W Meislin

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Courses

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Scholarly Contributions

Books

• Meislin, H. W., & Walter, F. G. (2017). Advanced Hazmat Life Support Instructor Manual, 4th edition. Tucson, AZ: The University of Arizona, Arizona Board of Regents.
• Meislin, H. W. (2015). Advanced Hazmat Instructor Manual.

Chapters

• Walter, F. G., Meislin, H. W., Crounse, D. M., & Williams, A. S. (2017). Chapter 1: Introduction to AHLS. In Advanced Hazmat Life Support Instructor Manual, 4th edition(pp 5-8). Tucson, AZ: The University of Arizona, Arizona Board of Regents.
• Williams, A. S., Crounse, D. M., Meislin, H. W., & Walter, F. G. (2017). Chapter 2: AHLS Infrastructure. In Advanced Hazmat Life Support Instructor Manual, 4th edition(pp 11-20). Tucson, AZ: The University of Arizona, Arizona Board of Regents.
• Williams, A. S., Crounse, D. M., Meislin, H. W., & Walter, F. G. (2017). Chapter 3: AHLS Courses. In Advanced Hazmat Life Support Instructor Manual, 4th edition(pp 23-33). Tucson, AZ: The University of Arizona, Arizona Board of Regents.
• Meislin, H. W. (2015). Chapter 1: Introduction to AHLS. In Advanced Hazmat Instructor Manual.
• Meislin, H. W. (2015). Chapter 4: Conducting an AHLS Course. In Advanced Hazmat Instructor Manual.
• Meislin, H. W. (2015). Chapter 5: A Checklist for Conducting an AHLS Course. In Advanced Hazmat Instructor Manual.
• Meislin, H. W. (2015). Chapter 6: Adult Education. In Advanced Hazmat Instructor Manual.
• Meislin, H. W. (2015). Chapter 7: Lectures and Tabletop Exercises: The Critical Points of AHLS. In Advanced Hazmat Instructor Manual.
• Meislin, H. W. (2015). Chapter2: AHLS Faculty. In Advanced Hazmat Instructor Manual.

Journals/Publications

• Meislin, H. W., Spaite, D. W., Conroy, C., Detwiler, M., & Valenzuela, T. D. (2016). Development of an electronic emergency medical services patient care record. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 3(1), 54-9.
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  The need for valid and reliable emergency medical services (EMS) data has long been recognized. EMS data are useful for monitoring resources and operations, documenting patient care and outcome, and evaluating injury prevention strategies. The goal of this project was to develop a computerized data set with the capability to generate a patient care record (PCR) to overcome some of the current EMS data limitations.
• Spaite, D. W., Conroy, C., Tibbitts, M., Karriker, K. J., Seng, M., Battaglia, N., Criss, E. A., Valenzuela, T. D., & Meislin, H. W. (2016). Use of emergency medical services by children with special health care needs. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 4(1), 19-23.
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  This study describes emergency medical services (EMS) responses for children with special health care needs (CSHCN) in an urban area over a one-year period.
• Spaite, D. W., Valenzuela, T. D., & Meislin, H. W. (2016). Physician in-field observation of prehospital advanced life support personnel: a statewide evaluation. Prehospital and disaster medicine, 8(4), 299-302.
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  Direct physician observation of advanced life support (ALS) personnel is rare in a demographically diverse state.
• de Witt, B., Joshi, R., Meislin, H., & Mosier, J. M. (2014). Optimizing oxygen delivery in the critically ill: assessment of volume responsiveness in the septic patient. The Journal of emergency medicine, 47(5), 608-15.
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  Assessing volume responsiveness, defined as an increase in cardiac index after infusion of fluids, is important when caring for critically ill patients in septic shock, as both under- and over-resuscitation can worsen outcomes. This review article describes the currently available methods of assessing volume responsiveness for critically ill patients in the emergency department, with a focus on patients in septic shock.
• Gaither, J. B., Spaite, D. W., Bobrow, B. J., Denninghoff, K. R., Stolz, U., Beskind, D. L., & Meislin, H. W. (2012). Balancing the potential risks and benefits of out-of-hospital intubation in traumatic brain injury: the intubation/hyperventilation effect. Annals of emergency medicine, 60(6), 732-6.
• Crounse, D., Meislin, H. W., Munger, B., & Walter, F. G. (2004). Advanced Hazmat Life Support (AHLS): Development and Demographics from 1999 through 2003. The Internet Journal of Internal Medicine, 5(1).
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  This is a prospective, descriptive, feasibility study to determine whether an interdisciplinary group of healthcare experts could design and successfully deliver an international, life support, continuing education program that teaches the medical management of hazmat patients. The interdisciplinary experts designed and delivered the two-day Advanced Hazmat Life Support (AHLS) Provider Course, the six hour AHLS Instructor Course, and the five hour AHLS for Toxic Terrorism Course. The AHLS Provider Course trained 3,036 healthcare professionals worldwide from 1999-2003. The AHLS Instructor Course trained 1,346 healthcare professionals worldwide from 1999-2003. The AHLS for Toxic Terrorism Course trained 138 healthcare professionals, starting in 2003. Healthcare professionals from 43 countries received AHLS training. The Advanced Hazmat Life Support Program is feasible and meets the continuing education needs of healthcare professionals around the world.
• Leikin, J. B., Thomas, R. G., Walter, F. G., Klein, R., & Meislin, H. W. (2002). A review of nerve agent exposure for the critical care physician. Critical care medicine, 30(10), 2346-54.
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  Nerve agents are discussed. The article discusses their properties, routes of exposure, toxicodynamics, targets of toxicity, and treatment. It is concluded that a focused organized approach to the treatment of nerve agents is key to its successful management.
• Spaite, D. W., Karriker, K. J., Seng, M., Conroy, C., Battaglia, N., Tibbitts, M., Meislin, H. W., Salik, R. M., & Valenzuela, T. D. (2000). Increasing paramedics' comfort and knowledge about children with special health care needs. The American journal of emergency medicine, 18(7), 747-52.
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  This study evaluated a continuing education program for paramedics about children with special health care needs (CSHCN). Pretraining, posttraining, and follow-up surveys containing two scales (comfort with CSHCN management skills and comfort with Pediatric Advanced Life Support [PALS] skills) were administered. Objective measures of knowledge were obtained from pre- and posttraining tests. Differences in average scores were assessed using t-tests. Response rates for paramedics completing the program ranged from 94% for the posttraining survey, 81% for the initial comfort survey, 56% for the knowledge pretest, and 56% for the follow-up survey. PALS comfort scores were significantly higher than CSHCN comfort scores both before and after training, both P < .01. Posttraining surveys showed an increase in CSHCN comfort, P < .01. The follow-up surveys showed a significant decline in CSHCN comfort, P = .05. Scores on the tests showed a similar pattern, with a significant increase in knowledge from pre- to posttraining (P = .02) and a significant decrease in knowledge from posttraining to follow-up (P < .01). Comfort was significantly higher for standard pediatric skills than for specialized management skills. Completion of the self-study program was associated with an increase in comfort and knowledge, but there was some decay over time.
• Meislin, H. W., Conn, J. B., Conroy, C., & Tibbitts, M. (1999). Emergency medical service agency definitions of response intervals. Annals of Emergency Medicine, 34(Issue 4 I). doi:10.1016/s0196-0644(99)80046-8
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  Study objective: There is a time continuum from emergency medical services (EMS) dispatch, response, scene, transport, and arrival at the hospital. Previous research has documented favorable patient outcome with short response intervals; however, these studies revealed the documentation of EMS time intervals is not always consistent. This study evaluates how agencies estimate these times and factors that may affect the length of response intervals. Methods: The study used a mail questionnaire to assess factors related to response intervals and to determine how agencies define and record response intervals. All ground-based EMS agencies in a southwestern state were invited to participate in the survey. Univariate and stratified data analyses compared definitions of response intervals. Results: Agencies varied as to how they defined the start and end of the response. Fifty-six percent stated that their response started when the responding unit was notified of the call. However, almost 23% defined response interval as starting when dispatch received the call, and 11% defined it as starting with the initial 911 call. A factor that affected response intervals was routing of the 911 call. Less than 6% of agencies had only 1-call routing. Conclusion: Agencies use different time points as the start and end of their response interval, which makes comparison of results directly related to response intervals across agencies or regions difficult. To maintain an appropriate standard of prehospital emergency medical care throughout the state, the use of consistent standard terminology defining response intervals will help reach that goal.
• Meislin, H. W., Conn, J. B., Conroy, C., & Tibbitts, M. (1999). Emergency medical service agency definitions of response intervals. Annals of emergency medicine, 34(4 Pt 1), 453-8.
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  There is a time continuum from emergency medical services (EMS) dispatch, response, scene, transport, and arrival at the hospital. Previous research has documented favorable patient outcome with short response intervals; however, these studies revealed the documentation of EMS time intervals is not always consistent. This study evaluates how agencies estimate these times and factors that may affect the length of response intervals.
• Meislin, H., Conroy, C., Conn, K., & Parks, B. (1999). Fatal injury: characteristics and prevention of deaths at the scene. The Journal of trauma, 46(3), 457-61.
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  Almost half of all trauma deaths occur at the scene. It is important to determine if these deaths can be prevented.
• Berger, R., Conroy, C., Criss, E. A., Judkins, D., Meislin, H. W., Parks, B. O., Spaite, D. W., & Valenzuela, T. D. (1998). Fatal Trauma: The Modal Distribution of Time to Death As a Function of Patient Demographics and Regional Resurces. Journal of Trauma Nursing, 5(1), 17-18. doi:10.1097/00043860-199801000-00005
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  The study included all deaths due to injury occurring under the jurisdiction of the County Medical Examiner (ME) between November 15, 1991, and November 14, 1993. Exclusions included deaths due to drowning, poisonings, overdoses, or burns; patients transported by private vehicle; or those injuries or deaths occurring outside the county or on Native American land. The area under study covered approximately 9,100 square miles and included one major metropolitan area. Most residents in the county had access to 911, although a portion residing in sparsely populated, frontier areas did not. Cases were identified by manual review of death records in the MEs office. Other sources of information included hospital records, trauma registries, and EMS reports. A consensus approach was utilized to develop standard definitions for time of death, time of injury, and dispatch time. Each case was assigned to an outcome category based on injuries as coded by 1CD-9 CM codes. These were neurologic, circulatory collapse or hemorrhage, ventilatory, sepsis, organ failure, or other. A total of 776 deaths were recorded, with 56 not meeting inclusion criteria. Fifty-two percent of the victims were pronounced dead on the scene, and the most common mechanism of injury was self-inflicted gunshot wounds. This study noted a bimodal distribution of death. The greatest number of deaths occurred 24-48 hours after injury; half of these were classified as neurologic, and another 42% were from circulatory collapse or hemorrhage. Patients expiring within 60 minutes of injury formed the next highest peak: 46.3% were neurologic and 31.3% were from circulatory collapse. Falls were found to be the most common mechanism in patients dying 2 days to 3 weeks after trauma. © 1998 Lippincott Williams & Wilkins, Inc.
• Spaite, D. W., Criss, E. A., Valenzuela, T. D., & Meislin, H. W. (1998). Prehospital advanced life support for major trauma: critical need for clinical trials. Annals of emergency medicine, 32(4), 480-9.
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  A widely diverse body of information exists on the use of Advanced Life Support procedures by prehospital personnel. We compared and contrasted the literature that currently exists on this topic. We examined methodologies, results, and conclusions for each article. We also stress the need for critical clinical evaluations in this arena.
• Farris, C., Spaite, D. W., Criss, E. A., Valenzuela, T. D., & Meislin, H. W. (1997). Observational evaluation of compliance with traffic regulations among helmeted and nonhelmeted bicyclists. Annals of emergency medicine, 29(5), 625-9.
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  To evaluate whether helmeted bicyclists are more compliant with traffic regulations than nonhelmeted bicyclists.
• Meislin, H. W. (1997). Injury control: the cure for trauma. Emergency medical services, 26(7), 57-60.
• Meislin, H., Criss, E. A., Judkins, D., Berger, R., Conroy, C., Parks, B., Spaite, D. W., & Valenzuela, T. D. (1997). Fatal trauma: the modal distribution of time to death is a function of patient demographics and regional resources. The Journal of trauma, 43(3), 433-40.
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  Unlike previous studies in an urban environment, this study examines traumatic death in a geographically diverse county in the southwestern United States.
• Spaite, D. W., Criss, E. A., Valenzuela, T. D., & Meislin, H. W. (1997). Developing a foundation for the evaluation of expanded-scope EMS: a window of opportunity that cannot be ignored. Annals of emergency medicine, 30(6), 791-6.
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  EMS systems are about to undergo a major transformation. Not only will the scope of EMS change, but many experts believe that it will dramatically expand. Some see the "expanded scope" as entailing relatively limited changes, whereas others consider them to be more broad. Although no agreement is evident about the definition for expanded-scope EMS, it is hoped that all EMS professionals can agree that it must be implemented in a manner that can be carefully evaluated to determine its effects on patients and EMS systems. We present a framework for evaluating the effect of expanded-scope EMS in the various types of systems that currently exist. Special consideration must be given to the indirect effects that system changes may have on survival from out-of-hospital cardiac arrest. Numerous issues will affect our ability to properly assess expanded-scope EMS. The basic research models necessary to assess the impact of system change are lacking. Few EMS systems consistently produce significant volumes of good systems research ... that is, there are few "EMS laboratories." Cost-effectiveness and issues surrounding the "societal value" of EMS remain essentially unstudied. Reliable scoring methods, severity scales, and outcome measures are lacking: and, it is ethically and logistically difficult to justify withholding the "standard of care" in an effort to understand the impact of EMS interventions. Despite all of these barriers, it is time to pay the price of doing methodologically sound evaluations that ensure the most optimal societal impact by the EMS systems of the future.
• Levine, R. J., Guisto, J. A., Meislin, H. W., & Spaite, D. W. (1996). Analysis of federally imposed penalties for violations of the Consolidated Omnibus Reconciliation Act. Annals of emergency medicine, 28(1), 45-50.
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  To identify the incidence of federally imposed penalties for violations of the Consolidated Omnibus Reconciliation Act (COBRA).
• Levine, R., Spaite, D. W., Valenzuela, T. D., Criss, E. A., Wright, A. L., & Meislin, H. W. (1995). Comparison of clinically significant infection rates among prehospital-versus in-hospital-initiated i.v. lines. Annals of emergency medicine, 25(4), 502-6.
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  To compare the risk of infection for i.v. lines placed in the prehospital versus in the in-hospital setting in a midsized emergency medical service system.
• Spaite, D. W., Criss, E. A., Weist, D. J., Valenzuela, T. D., Judkins, D., & Meislin, H. W. (1995). A prospective investigation of the impact of alcohol consumption on helmet use, injury severity, medical resource utilization, and health care costs in bicycle-related trauma. The Journal of trauma, 38(2), 287-90.
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  To examine if a relationship exists between bicycle-related injuries, consumption of alcohol, helmet use, and medical resource utilization.
• Criss, E. A., Levine, R. M., Meislin, H. W., Spaite, D. W., Valenzuela, T. D., & Wright, A. L. (1994). Comparison of Clinically Significant Infection Rates Among Prehospital Versus In-hospital Initiated Intravenous lines. Prehospital and Disaster Medicine, 9(S2), S53-S53. doi:10.1017/s1049023x00050093
• Spaite, D. W., Valenzuela, T. D., Criss, E. A., Meislin, H. W., & Hinsberg, P. (1994). A prospective in-field comparison of intravenous line placement by urban and nonurban emergency medical services personnel. Annals of emergency medicine, 24(2), 209-14.
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  Emergency medical services personnel are highly proficient at rapid i.v. line placement in the prehospital setting, with little difference between urban and nonurban areas in a geographically diverse state.
• Meislin, H. W., & Munger, B. S. (1993). Editorial. Annals of Emergency Medicine, 22(Issue 1). doi:10.1016/s0196-0644(05)80267-7
• Meislin, H. W., & Munger, B. S. (1993). Emergency medicine 2000: residencies, resident graduates, and ABEM diplomates. Annals of emergency medicine, 22(1), 132-4.
• Meislin, H. W., Spaite, D. W., & Valenzuela, T. D. (1993). Barriers to EMS system evaluation problems associated with field data collection. Prehospital and Disaster Medicine, 8(1), S35-S40. doi:10.1017/s1049023x00067509
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  For more than two decades, emergency medical services (EMS) systems have proliferated primarily based upon governmental impetus and funding at the federal, state, and local levels. Although many of the foundations of patient care rendered in these systems have been based upon intuitive logic, the understanding of the impact on patient outcome is poor, at best. The reasons for the current status are varied, but five issues are preeminent:1) The authority for the development of these medical systems has been based primarily in political and bureaucratic institutions which have little or no medical expertise;2) Little attention has been paid to system evaluation, particularly in the area of cost-effectiveness;3) Few academic medical institutions have become involved in EMS research;4) Traditional approaches to medical research primarily are disease-specific and are not multidisciplinary. Thus these are not useful for evaluating and understanding the highly complex and uncontrolled environmental interactions that typify EMS systems; and5) The process of efficiently and reliably collecting accurate data in the prehospital setting is extremely difficult.
• Spaite, D. W., Valenzuela, T. D., Meislin, H. W., Criss, E. A., & Hinsberg, P. (1993). Prospective validation of a new model for evaluating emergency medical services systems by in-field observation of specific time intervals in prehospital care. Annals of emergency medicine, 22(4), 638-45.
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  To develop and validate a new time interval model for evaluating operational and patient care issues in emergency medical service (EMS) systems. DESIGN/SETTING/TYPE OF PARTICIPANT: Prospective analysis of 300 EMS responses among 20 advanced life support agencies throughout an entire state by direct, in-field observation.
• Valenzuela, T. D., Brown, J. F., Keim, S. M., Meislin, H. W., Spaite, D. W., & Valenzuela, T. D. (1993). 250 Penetrating Trauma: Severity, Cost, and Reimbursement. Prehospital and Disaster Medicine, 8(S3), S130-S130. doi:10.1017/s1049023x00048615
• Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Clark, L. L., Wright, A. L., & Ewy, G. A. (1993). Emergency vehicle intervals versus collapse-to-CPR and collapse-to-defibrillation intervals: monitoring emergency medical services system performance in sudden cardiac arrest. Annals of emergency medicine, 22(11), 1678-83.
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  To compare emergency vehicle response intervals with collapse-to-intervention intervals to determine which of these system data better correlated with survival after prehospital sudden cardiac arrest.
• Brophy, T., Criss, E. A., Hinsberg, P., Meislin, H. W., Spaite, D. W., & Valenzuela, T. D. (1992). A New Model for Evaluating the Impact of Major System Changes on Emergency Air Medical Scene Responses in a Regional EMS System. Prehospital and Disaster Medicine, 7(1), 19-23. doi:10.1017/s1049023x00039157
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  Hypothesis:Centralized dispatch data can provide useful information regarding the impact of major air medical system changes in a regional emergency medical services (EMS) system.Methods:Prospective evaluation of helicopter dispatch data from a centralized EMS dispatch agency. During the study period, four alterations in the total number of helicopters available to the system occurred (1,2,3,2,3). Statistical analysis consisted of Chi-Square with Yates' correction and comparison of sample proportions with p
• Clark, L. L., Meislin, H. W., Sayre, R. O., Spaite, D. W., & Valenzuela, T. D. (1992). Estimated Cost-Effectiveness of Dispatcher CPR Instruction via Telephone to Bystanders During Out-of-Hospital Ventricular Fibrillation. Prehospital and Disaster Medicine, 7(3), 229-233. doi:10.1017/s1049023x00039558
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  Hypothesis:Emergency cardiopulmonary resuscitation (CPR) instruction via telephone (ETCPR) is cost-effective compared to prehospital, emergency medical technician (EMT)/paramedic treatment alone of witnessed, ventricular fibrillation (VF) in adult patients.Methods:A total of 118 patients, age >18 years, with prehospital, witnessed ventricular fibrillation were studied. Patient data were extracted from hospital records, monitor-defibrillator recordings, paramedic reports, dispatching records, and telephone interviews with bystanders. No ETCPR was available during this period. The costs of ETCPR implementation were estimated retrospectively. Marginal cost of the paramedic service attributable to treatment of VF was calculated from fire department records. Years-of-life saved were estimated from age, gender, and race matched norms.Results:Of the 53 patients receiving bystander CPR (BCPR), 14 (26%) survived to hospital discharge versus 4/65 patients (6%) lacking BCPR, These groups did not differ significantly (p>.05) in age, EMS response times, or time from collapse to defibrillation. The mean time interval from collapse to CPR was significantly less for patients with BCPR (1.8 min) than for patients without BCPR (7.1 min). Had all patients received BCPR and survived at the rate of 0.26, 13 additional patients would have survived to hospital discharge. The cost per year-of-life saved by the EMS system with ETCPR would have been [US]$560 in patients experiencing out-of-hospital ventricular fibrillation.Conclusion:The use of ETCPR instruction of callers by 9-1-1 dispatchers potentially is a cost-effective addition to a two-tier, EMS system for treatment of prehospital ventricular fibrillation.
• Criss, E. A., Meislin, H. W., Ross, J., Spaite, D. W., & Valenzuela, T. D. (1992). A Prospective Evaluation of the Impact of Initial Glasgow Coma Score on Prehospital Treatment and Transport of Seizure Patients. Prehospital and Disaster Medicine, 7(2), 127-132. doi:10.1017/s1049023x00039352
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  Hypothesis:The initial Glasgow Coma Score (GCS) obtained by prehospital personnel on seizure victims is associated with the likelihood of treatment and transport.Methods:Prehospital data were collected prospectively for all patients presenting with seizures to a mid-sized emergency medical services system during a five-month period. A total of 419 cases occurred (62.8% male, 37.2% female). Seizure frequency was highest in infants under the age of three years and in adults in their late 20s. A GCS was recorded in 378 cases (90.2%, study group). The GCS was >10 in 304 patients (80.4%) and ≤10 in 74 (19.6%). Patients with GCS≤10 were more likely to receive: oxygen (50.0% vs. 20.1%, p 10. However, the clinical indicators that were used to make the decision that it was “safe” not to transport nearly one-third of the patients are unclear. Essentially no data exist regarding the parameters impacting treatment and transport of seizure patients. Future investigations with outcome data, are needed to determine whether low risk criteria can be developed to identify those patients (if any) that do not require treatment or transport. A GCS may provide an objective, reproducible parameter upon which to begin formulating such criteria.
• Meislin, H. W. (1992). Academic emergency medicine. Annals of emergency medicine, 21(8), 984.
• Meislin, H. W. (1992). Emergency medicine, "where are ye?". Annals of emergency medicine, 21(2), 169.
• Meislin, H. W., Spaite, D. W., & Valenzuela, T. D. (1992). Meeting the goals of academia: characteristics of emergency medicine faculty academic work styles. Annals of emergency medicine, 21(3), 298-302.
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  Emergency medicine faculty have 24-hour clinical responsibilities in addition to the academic requirements of research and administration/teaching. This study was undertaken to determine the existing and ideal work style of such faculty by professional rank, administrative title, and/or tenure versus clinical track.
• Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Clark, L. L., Wright, A. L., & Ewy, G. A. (1992). Case and survival definitions in out-of-hospital cardiac arrest. Effect on survival rate calculation. JAMA, 267(2), 272-4.
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  To determine the effect of different case and survival definitions of out-of-hospital cardiac arrest on survival rate calculations.
• Criss, E. A., Meislin, H. W., Murphy, M. E., Spaite, D. W., & Valenzuela, T. D. (1991). A prospective analysis of injury severity among helmeted and nonhelmeted bicyclists involved in collisions with motor vehicles.. The Journal of trauma, 31(11), 1510-6. doi:10.1097/00005373-199111000-00008
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  To evaluate the impact of helmet use on injury severity, patient information was prospectively obtained for all bicyclists involved in collisions with motor vehicles seen at a level-I trauma center from January 1986 to January 1989. Two hundred ninety-eight patients were evaluated; in 284 (95.3%, study group) cases there was documentation of helmet use or nonuse. One hundred sixteen patients (40.9%) wore helmets and 168 (59.1%) did not. One hundred ninety-nine patients (70.1%) had an ISS less than 15, while 85 (29.9%) were severely injured (ISS greater than 15). Only 5.2% of helmet users (6/116) had an ISS greater than 15 compared with 47.0% (79/168) of nonusers (p less than 0.0001). The mean ISS for helmet users was 3.8 compared with 18.0 for nonusers (p less than 0.0001). Mortality was higher for nonusers (10/168, 6.0%) than for helmet users (1/116, 0.9%; p less than 0.025). A striking finding was noted when the group of patients without major head injuries (246) was analyzed separately. Helmet users in this group still had a much lower mean ISS (3.6 vs. 12.9, p less than 0.001) and were much less likely to have an ISS greater than 15 (4.4% vs. 32.1%, p less than 0.0001) than were nonusers. In this group, 42 of 47 patients with an ISS greater than 15 (89.4%) were not wearing helmets. We conclude that helmet nonuse is strongly associated with severe injuries in this study population. This is true even when the patients without major head injuries are analyzed as a group; a finding to our knowledge not previously described.(ABSTRACT TRUNCATED AT 250 WORDS)
• Criss, E. A., Meislin, H. W., Ross, J., Spaite, D. W., & Valenzuela, T. D. (1991). Analysis of Prehospital Scene Time and Survival from Out-of-Hospital, Non-Traumatic, Cardiac Arrest. Prehospital and Disaster Medicine, 6(1), 21-27. doi:10.1017/s1049023x00028028
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  AbstractThe purpose of this study was to determine whether shorter prehospital scene time (ST) is associated with an increased survival rate in non-traumatic, out-of-hospital, cardiac arrest (CA) in a medium-sized, metropolitan EMS system. Information was retrieved for all adult victims (age ≥18 years) of CA treated and transported by a metropolitan fire department over a 16month period (6/87–9/88). Data were retrieved from the fire department's database, hospital records, and death certificates. Statistical analysis of continuous variables was performed using the two-tailed, Student's t-test and non-parametric evaluations were performed by square analysis with p
• Clark, L., Criss, E. A., Meislin, H. W., Spaite, D. W., Valenzuela, T. D., & Wright, A. L. (1990). Cost-effectiveness analysis of paramedic emergency medical services in the treatment of prehospital cardiopulmonary arrest.. Annals of emergency medicine, 19(12), 1407-11. doi:10.1016/s0196-0644(05)82609-5
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  1) Identification of marginal costs associated with prehospital resuscitation of cardiopulmonary arrest; 2) Determination of cost effectiveness for such resuscitation; and 3) Comparison of cost effectiveness of paramedic care with selected other medical interventions..Retrospective review of 190 cases of out-of-hospital cardiac arrest..City limits of a midsized southwestern city. The events studied took place outside of medical facilities..Victims of out-of-hospital cardiac arrest for whom the EMS system was activated by a 911 telephone request for emergency medical assistance..The cost, including training, personnel, equipment, and response time maintenance, per year of life saved was found to be $8,886.00 for paramedic care. This result was compared with published cost-effectiveness figures for heart transplantation, liver transplantation, bone marrow transplantation, and chemotherapy for acute leukemia. Paramedic care was more cost effective, as measured by cost per year of life saved, than organ transplantation and chemotherapy for acute leukemia..Out-of-hospital treatment by paramedics of cardiopulmonary arrest is more cost effective than heart, liver, bone marrow transplantation, or curative chemotherapy for acute leukemia.
• Criss, E. A., Hinsberg, P., Meislin, H. W., Spaite, D. W., & Valenzuela, T. D. (1990). A Prospective Evaluation of Prehospital Patient Assessment by Direct In-field Observation: Failure of ALS Personnel to Measure Vital Signs. Prehospital and Disaster Medicine, 5(4), 325-333. doi:10.1017/s1049023x00027060
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  We prospectively evaluated the frequency with which advanced life support (ALS) personnel fail to attempt to measure blood pressure (BP) and/or pulse (P) during prehospital patient assessment. A single in-field observer rode on ALS rescue vehicles from 20 Emergency Medical Services (EMS) agencies throughout Arizona during a one-year study (1/89–12/89). Data were collected from urban, suburban, and rural systems. Statistical evaluation was performed by Chi Square analysis with p
• Criss, E. A., Meislin, H. W., Nelson, A., Smith, R., Spaite, D. W., & Valenzuela, T. D. (1990). Banning alcohol in a major college stadium: impact on the incidence and patterns of injury and illness.. Journal of American college health : J of ACH, 39(3), 125-8. doi:10.1080/07448481.1990.9936223
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  To evaluate the effect of banning alcohol on the incidence of injuries and illness among spectators, we reviewed 4 years (1983 to 1986) of medical incident reports from a major collegiate football stadium. At no time had alcoholic beverages been sold inside the stadium, but before 1985, fans were allowed to bring alcohol into the stadium. In 1985, this practice was banned. During the study period, 340 medical incidents (M = 12.6/game) were reported. Several alterations of specific injury/illness patterns were noted after initiation of the ban: heat-related illness occurred more frequently before initiation of the ban, whereas extremity injuries and syncope (fainting from coronary insufficiency) occurred with greater frequency afterwards. The injury/illness rates per 10,000 fans were 2.95 in 1983, 2.45 in 1984, 1.92 in 1985, and 3.48 in 1986. There was no significant change in the overall incident rate after the ban. Evaluation of medical incidents revealed an alteration in specific injury/illness patterns but no change in overall incidence after institution of the ban. Future investigations are needed to elucidate more clearly the impact of banning alcohol on injury/illness rates and patterns at mass gatherings.
• Criss, E. A., Meislin, H. W., Ross, J., Spaite, D. W., & Valenzuela, T. D. (1990). Geriatric injury: an analysis of prehospital demographics, mechanisms, and patterns.. Annals of emergency medicine, 19(12), 1418-21. doi:10.1016/s0196-0644(05)82611-3
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  To evaluate emergency medical services (EMS) system use, injury mechanisms, and prehospital assessments among elderly victims of trauma..We analyzed all prehospital data for injuries among patients 70 years old or older for whom 911 EMS dispatch was requested in a medium-sized metropolitan area during a 12-month period..A total of 1,154 cases occurred (women, 65.1%), which represented 30.3% of all 911 dispatches involving elderly patients. Injury mechanisms were fall (60.7%), motor vehicle accident (MVA; 21.5%), fight (2.4%), accidental poisoning (2.3%), and choking (2.1%). Persons in their 90s had a lower frequency of MVAs (3.4%) than did younger patients (23.0%) (P less than .005). The most frequent injuries determined by prehospital assessment were head or face (25.1%), upper extremity (17.2%), hip (14.5%), lower extremity (13.8%), back (9.8%), and chest or abdomen (5.0%). The frequency of serious neurologic injuries was less for falls or MVAs than for other mechanisms (P less than .005). Suspected hip (P less than .001) and pelvic (P less than .005) injuries occurred more frequently during falls than during other mechanisms of injury, whereas back injuries occurred most frequently in MVAs (P less than .001). Seventy-one fall victims (10.1%) had suspected medical causes of their fall. Twelve patients (1.0%) were in cardiac arrest..We report injury patterns and mechanisms among elderly victims of trauma presenting to an EMS system. A knowledge of these patterns will be useful to emergency physicians and EMS administrators.
• Rappaport, W., & Meislin, H. (1990). Left lower quadrant pain in an elderly man. Drug Therapy, 20(9).
• Criss, E. A., Goldberg, J., Meislin, H. W., Spaite, D. W., Valenzuela, T. D., & Valenzuela, T. D. (1989). Development of a computer model to predict EMS system performance after changes in number, location, and area of responsibility of EMS units. Annals of Emergency Medicine, 18(4), 438. doi:10.1016/s0196-0644(89)80625-0
• Criss, E. A., Keeley, K. T., Meislin, H. W., Spaite, D. W., & Valenzuela, T. D. (1989). Implementation of a computerized management information system in an urban fire department.. Annals of emergency medicine, 18(5), 573-8. doi:10.1016/s0196-0644(89)80847-9
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  An important aspect in the effective management of an emergency medical services system is the ability to monitor system performance. To provide this information on a timely basis, a comprehensive data collection system is required. We describe the design, implementation, use, and effect of a comprehensive, computerized data retrieval system within an urban fire department. Building on a data collection system already in place, it was possible to minimize the cost and accelerate the training process. A comparison is included between the different type of systems available for use with prehospital providers. Use of prehospital data collection systems results in more in-depth understanding of system operations and the status of prehospital medical care provided to the community.
• Criss, E. A., Meislin, H. W., Spaite, D. W., & Valenzuela, T. D. (1989). Evaluation of EMS management training offered during emergency medicine residency training.. Annals of emergency medicine, 18(8), 812-4. doi:10.1016/s0196-0644(89)80201-x
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  Physician involvement in the provision of both direct and indirect medical control to emergency medical providers is critical to the effective operation of an emergency medical services (EMS) system. We conducted a survey of all accredited emergency medicine residency programs in the United States to determine the content of EMS instruction provided to these physicians-in-training. The majority of programs provide an introduction to direct medical control, to EMS organizational structure, and the opportunity to participate in EMS-related research. Less than 65%, however, provide formal instruction in EMS risk management or quality assurance or the opportunity to observe policy-making bodies related to EMS. The importance placed on EMS during residency training is variable. EMS is the domain of emergency medicine, and adequate training of residents for these responsibilities is imperative.
• Coates, S. A., Cyr, J., Meislin, H. W., Valenzuela, T. D., & Valenzuela, T. (1988). Fast Track: urgent care within a teaching hospital emergency department: can it work?. Annals of emergency medicine, 17(5), 453-6. doi:10.1016/s0196-0644(88)80235-x
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  We performed a ten-week study to understand the feasibility of a fast track system within a teaching hospital setting. Our results show that 50% or fewer of patients entering an emergency department during evening and weekend day hours can be seen in Fast Track. Average turnaround time for all patients in the ED was 161 minutes. The average for all Fast Track patients was 94.5 minutes; if laboratory and/or radiographs were ordered the average was 121.5 minutes; with no laboratory/radiographs, 79.1 minutes. Urinalysis, strep screen, and complete blood count accounted for 80% of all laboratory work. Roentgenograms of the ankle, foot, and knee accounted for 80% of all radiographs. An evaluation questionnaire showed enhanced satisfaction with a reduction in the number of complaints from 79% to 22%. The Fast Track system failed when there was a predominance of acutely ill patients in the ED, as house officers were pulled to care for the acutely ill patients.
• Criss, E. A., Meislin, H. W., Nelson, A., Smith, R., Spaite, D. W., & Valenzuela, T. D. (1988). A new model for providing prehospital medical care in large stadiums.. Annals of emergency medicine, 17(8), 825-8. doi:10.1016/s0196-0644(88)80563-8
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  To determine proper priorities for the provision of health care in large stadiums, we studied the medical incident patterns occurring in a major college facility and combined this with previously reported information from four other large stadiums. Medical incidents were an uncommon occurrence (1.20 to 5.23 per 10,000 people) with true medical emergencies being even more unusual (0.09 to 0.31 per 10,000 people). Cardiac arrest was rare (0.01 to 0.04 events per 10,000 people). However, the rates of successful resuscitation in three studies were 85% or higher. The previous studies were descriptive in nature and failed to provide specific recommendations for medical aid system configuration or response times. A model is proposed to provide rapid response of advanced life support care to victims of cardiac arrest. We believe that the use of this model in large stadiums throughout the United States could save as many as 100 lives during each football season.
• Criss, E. A., Grazer, R. E., Meislin, H. W., & Westerman, B. R. (1987). A nine-year evaluation of emergency department personnel exposure to ionizing radiation.. Annals of emergency medicine, 16(3), 340-2. doi:10.1016/s0196-0644(87)80183-x
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  Emergency department personnel experience potential occupational hazards from exposure to ionizing radiation (x-rays). To assess this risk, ionizing radiation exposure was analyzed during a nine-year period for 128 ED personnel. The group consisted of 21 physicians, 92 nurses, and 15 ancillary personnel. Exposure was measured for both penetrating and nonpenetrating radiation using standard film dosimeter badges. Film badge use compliance was 66.7% for physicians, 86.2% for nurses, and 86.7% for ancillary personnel. Penetrating radiation exposure averaged 0.12 mrem/month for physicians, 0.70 mrem/month for nurses, and 0 mrem/month for ancillary personnel, all less than the average natural background exposure. We concluded that if standard radiation precautions are taken, the occupational risk from ionizing radiation exposure to personnel in the ED is minimal, and that routine monitoring of radiation exposure of ED personnel is unnecessary.
• Criss, E. A., Grazer, R. E., Meislin, H. W., & Westerman, B. R. (1987). Exposure to ionizing radiation in the emergency department from commonly performed portable radiographs.. Annals of emergency medicine, 16(4), 417-20. doi:10.1016/s0196-0644(87)80363-3
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  To accurately assess the potential hazard of exposure to ionizing radiation from portable radiographs taken in the emergency department, a study was performed to measure such radiation at different distances from the edge of an irradiated field during portable cervical-spine (pC-S), portable chest radiograph (pCXR), and portable anteroposterior-pelvis (pAP-pelvis) radiographs. For all three types of portable radiographs, radiation exposure is a function of distance from the beam. However, at 40 cm (15 inches) away from the beam during a pC-S or pCXR and at 160 cm (63 inches) from a pAP-pelvis film, exposure is minimal. At these distances one would need to be exposed to more than 1,200 such radiographs to equal background environmental ionizing radiation. Medical personnel should not have to leave a patient care area for fear of undue acute and chronic radiation exposure while portable radiographs are performed in the ED. By using protective garments and standing appropriate distances away from the patient, continuous patient care can be maintained while portable radiographs are taken in the ED.
• Meislin, H. W. (1987). Incarceration of the gravid uterus.. Annals of emergency medicine, 16(10), 1177-8. doi:10.1016/s0196-0644(87)80484-5
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  Incarceration of the gravid uterus is a rare but serious complication of pregnancy. Reported is the case of a gravida 2, para 1 26-year-old woman who presented with lower abdominal pain. The patient was 14 weeks pregnant and presented with a one-day history of abdominal pain and vaginal discharge. Examination revealed a retroflexed uterus with the cervical opening pointing toward the anterior abdominal wall. An ultrasound revealed a uterus incarcerated between the sacral promontory and the pubis. Manual reduction was performed successfully in the emergency department.
• Allen, D., Criss, E. A., Meislin, H. W., Raife, J., Sanders, A. B., & Steckl, P. (1986). An analysis of medical care at mass gatherings.. Annals of emergency medicine, 15(5), 515-9. doi:10.1016/s0196-0644(86)80984-2
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  Emergency medical care at public gatherings is haphazard at best and dangerous at worst. The Arizona chapter of the American College of Emergency Physicians, through the Chapter Grant Program, studied the level of medical care provided at public gatherings in order to develop guidelines for emergency medical care at mass gatherings. The study consisted of a survey of medical care at 15 facilities providing events for the public. The results of these surveys showed a wide variation of medical care provided at mass events. Of the 490 medical encounters reviewed, 52.2% were within the realm of care of paramedics, but not basic emergency medical technicians. The most common injuries/illnesses were lacerations, sprains, headaches, and syncope. Problems noted included poor documentation and record keeping of medical encounters, a tendency for prehospital care personnel to make medical evaluations without transport or medical control, and variability of care provided. Based on this survey and a literature review, guidelines for medical care at mass gatherings in Arizona were determined using an objective-oriented approach. It is our position that event organizers have the responsibility of ensuring the availability of emergency medical services for spectators and participants. We recommend that state chapters or National ACEP evaluate the role of emergency medical care at mass gatherings.
• Blahd, W. H., Meislin, H. W., Rubin, M. J., & Stanisic, T. H. (1985). Diagnosis of intraperitoneal extravasation of urine by peritoneal lavage.. Annals of emergency medicine, 14(5), 433-7. doi:10.1016/s0196-0644(85)80287-0
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  The diagnosis of intraperitoneal extravasation of urine in the multiple trauma patient is often delayed, resulting in increased morbidity and mortality. To determine if intraperitoneal extravasation of urine can be detected by peritoneal lavage, an animal study was designed to investigate whether urea nitrogen and creatinine levels in the urine, serum, and lavage fluid would be predictive of urinary extravasation. Seventeen adult mongrel dogs, weighing 21 to 30 kg, were divided into two groups. The six dogs in Group 1 were utilized as controls, and had peritoneal lavage (15 mL normal saline/kg) performed using the open technique (direct visualization of the peritoneum). Blood, urine and lavage urea nitrogen and creatinine and lavage red cell count were measured. Group 2 (11 dogs) had varying amounts of urine (5 mL to 330 mL) instilled into the peritoneal cavity. Diagnostic peritoneal lavage was performed 30 to 45 minutes after the instillation of urine in all Group 2 animals. Group 2A (nine dogs) had urine instilled under direct visualization through a peritoneal lavage catheter. As bladder dome rupture is the most common cause of intraperitoneal urine extravasation, Group 2B (two dogs) had bladder dome ruptures performed by cystoscopic approach using the resectoscope. Cystograms were obtained in the bladder-ruptured dogs after completion of the peritoneal lavage to confirm intraperitoneal extravasation of bladder contents. In these animals, urine was instilled back into the bladder following bladder rupture. Results demonstrate that urea nitrogen and creatinine can be measured in peritoneal lavage fluid when extravasation of urine is in amounts of 15 mL or greater, and not measurable in amounts of 5 mL or less.(ABSTRACT TRUNCATED AT 250 WORDS)
• Criss, E. A., Grazer, R. E., Meislin, H. W., & Westerman, B. R. (1985). Abstract of the 15th Annual Meeting of the University Association for Emergency MedicineNine-year evaluation of Emergency Department personnel exposure to ionizing radiation. Annals of Emergency Medicine, 14(5), 509. doi:10.1016/s0196-0644(85)80394-2
• Iserson, K. V., Lee, S. C., & Meislin, H. W. (1985). Epiglottitis presenting as acute pulmonary edema.. Annals of emergency medicine, 14(1), 60-3. doi:10.1016/s0196-0644(85)80737-x
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  Presented is the case of a 2 1/2-year-old with acute pulmonary edema associated with epiglottitis prior to intubation. The patient complained only of odynophagia and had one brief episode of apnea and flaccid posturing. Chest radiograph demonstrated pulmonary edema. A soft tissue radiograph of the neck confirmed the diagnosis of epiglottitis. The patient was managed successfully with prompt intubation, PEEP, and antibiotics. Pulmonary edema associated with epiglottitis may be more common than previously recognized. It may occur prior to or after intubation. When pulmonary edema is clinically evident, PEEP should be administered early.
• Blahd, W. H., Meislin, H. W., Rubin, M. J., & Stanisic, T. H. (1984). DepartmentAbstract of the 14th Annual Meeting of the University Association for Emergency MedicineDiagnosis of intraperitoneal extravasation of urine via peritoneal lavage. Annals of Emergency Medicine, 13(5), 408. doi:10.1016/s0196-0644(84)80230-9
• Dart, R. C., Joyce, S. M., Lee, S. C., & Meislin, H. W. (1984). Abstracts of the 1984 scientific assembly, american college of emergency physiciansLiquid crystal thermometry for continuous temperature measurement in emergency department patients. Annals of Emergency Medicine, 13(10), 992-993. doi:10.1016/s0196-0644(84)80714-3
• Kern, K. B., & Meislin, H. W. (1984). Diabetes insipidus: occurrence after minor head trauma.. Journal of Trauma-injury Infection and Critical Care, 24(1), 69-72. doi:10.1097/00005373-198401000-00012
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  Post-traumatic diabetes insipidus is a rare entity, usually associated with severe head trauma, often with skull fracture and cranial nerve dysfunction. A 24-year-old male presented to a medical clinic 2 weeks after a minor head injury with presenting symptoms of polyuria with nocturia and intense polydipsia. A diagnosis of post-traumatic diabetes insipidus was made. Although other causes of polyuria syndromes must be ruled out, plotting urine versus plasma osmolalities can provide rapid preliminary diagnostic help when considering diabetes insipidus. First-line treatment should include a trial of chlorpropamide and hydrochlorothiazide. Caution should be exercised in not overlooking associated anterior pituitary damage, which may develop several years post-trauma.
• Levitt, M. A., Fleischer, A. S., & Meislin, H. W. (1984). Acute post-traumatic diabetes insipidus: Treatment with continuous intravenous vasopressin. Journal of Trauma - Injury, Infection and Critical Care, 24(Issue 6). doi:10.1097/00005373-198406000-00012
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  A young male presented within hours after closed head injury with hypotension, tachycardia, and polyuria. A diagnosis of post-traumatic diabetes insipidus was made. Although a rare entity, the rapid diagnosis of diabetes insipidus and early treatment with vasopressin may have been life-saving in this case. A detailed approach for treatment with continuous intravenous vasopressin may be the most accurate and efficient method of managing acute onset diabetes insipidus, especially in the hemodynamically compromised patient. This will allow for a controlled fluid management in order to achieve hemodynamic stability and prevent aggravation of cerebral edema. © 1984 by The Williams & Wilkins Co.
• Daub, E., Meislin, H. W., & Sanders, A. B. (1983). Alterations in MAST suit pressure with changes in ambient temperature.. The Journal of emergency medicine, 1(1), 37-44. doi:10.1016/0736-4679(83)90007-0
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  A study was undertaken to test the hypothesis that change in ambient air temperature has an effect on MAST suit pressure according to the ideal gas law. Two different MAST suits were tested on Resusci-Annie dummies. The MAST suits were applied in a cold room at 4.4 degrees C and warmed to 44 degrees C. Positive linear correlations were found in nine trials, but the two suits differed in their rate of increase in pressure. Three trials using humans were conducted showing increased pressure with temperature but at a lesser rate than with dummies. A correlation of 0.5 to 1.0 mm Hg increase in MAST suit pressure for each 1.0 degrees C increase in ambient temperature was found. Implications are discussed for the use of the MAST suit in environmental conditions where the temperature changes.
• Kobernick, M., & Meislin, H. W. (1983). Corn chip laceration of the esophagus and evaluation of suspected esophageal perforation.. Annals of emergency medicine, 12(7), 455-7. doi:10.1016/s0196-0644(83)80348-5
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  Two patients presented to the emergency department within three months with a laceration of the esophagus due to corn chip ingestion. Both complained of odynophagia, and each was evaluated for suspected perforation with confirming esophagrams. Both patients were treated nonoperatively with full recovery.
• Libby, J., & Meislin, H. W. (1983). Human rabies. Annals of Emergency Medicine, 12(Issue 4). doi:10.1016/s0196-0644(83)80598-8
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  A 40-year-old man who farmed in Mexico and raised dogs as a hobby presented with dysphagia, hydrophobia, insomnia, anorexia, malaise, fever, and decreased strength and sensation in his dominant arm. After a repetitive three-hour history and physical examination, a tentative diagnosis of rabies was made in an atmosphere of patient denial followed by reluctance of hospital personnel to accept such a rare diagnosis. Upon confirmation of the diagnosis by the Center for Disease Control, Atlanta, the patient underwent aggressive therapy, including maximum respiratory support, anticonvulsants, steroids, pressors, hemodialysis and interferon treatment, but died on the 16th day following admission. This case is presented because of its rarity and to review the disease, clinical history, current therapy, and recent literature regarding emergency department differential diagnosis. © 1983 American College of Emergency Physicians.
• Meislin, H. W., & Sanders, A. B. (1983). Effect of altitude change on MAST suit pressure.. Annals of emergency medicine, 12(3), 140-4. doi:10.1016/s0196-0644(83)80552-6
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  Transport of patients involving changes in altitude has become commonplace in the treatment of trauma patients. Often these patients are treated with medical antishock trouser (MAST) suits initially and during transport. The effects of altitude changes on the pressures generated in MAST suits were systematically investigated. Jobst Standard Antishock Air Pants were applied to the lower half of a Resusci-Anne dummy and inflated to 30 mm Hg of pressure. In a simulation of patient transport, the inflated MAST suit and dummy were placed in a helicopter and ascended from 2,500 feet to 9,500 feet. Pressures increased to 84, 87, and 87 mm Hg in three separate trials. Intermittent MAST suit pressure readings at 1,000-foot increments in altitude showed a positive linear relationship. Three descending trials, in which the MAST suit was inflated to 60 mm Hg at 9,500 feet and the helicopter descended to 2,500 feet, were also done. Pressures dropped to 7, 8.5, and 8 mm Hg in the three trials. A positive second order relationship between MAST suit pressure and altitude was noted for the descending trials. It was concluded that MAST suit pressure is a function of altitude. Emergency medicine personnel should be aware of this, and should monitor patients accordingly when transporting through changes in altitude.
• Meislin, H., & Kettel, L. (1982). Emergency medical services. Arizona Medicine, 39(4).
• Meislin, H. W. (1981). Development of an emergency medicine residency program by an emergency medicine residency graduate. Emergency Health Services Quarterly, 1(Issue 1). doi:10.1300/j260v01n01_10
• Sanders, A., Alcorn, E., Jellinek, L., & Meislin, H. (1981). Cutaneous infections and abscesses. Seminars in Family Medicine, 2(2).
• Furgurson, J., & Meislin, H. (1979). Airway problems in the trauma victim. Topics in Emergency Medicine, 1(1).
• Meislin, H. (1979). Foreword. Topics in Emergency Medicine, 1(1).
• Meislin, H. W. (1979). Author's reply. Journal of the American College of Emergency Physicians, 8(Issue 1). doi:10.1016/s0361-1124(79)80456-6
• Goldstein, E. J., Baraff, L. J., Meislin, H., Wield, B. J., Citron, D. M., & Finegold, S. M. (1978). Animal bites. Journal of the American College of Emergency Physicians, 7(Issue 11). doi:10.1016/s0361-1124(78)80171-3
• Meislin, H. W. (1977). Bacteroides in Pelvic Abscesses. New England Journal of Medicine, 297(Issue 14). doi:10.1056/nejm197710062971416
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  To the Editor: The article by Cunningham et al. (N Engl J Med 296:1380–1383, 1977) reported that pelvic abscesses were 10 times more common in women from whom Neisseria gonorrhoeae was not isolated. Studies of intra-abdominal infections and abscess formation have shown that peritonitis tends to be associated with aerobic organisms, whereas intra-abdominal abscesses demonstrate a predominance of anaerobic isolates.12 Antibiotics effective against Bacteroides fragilis decrease the incidence of intra-abdominal abscess formation, whereas drugs effective against enterococci and coliform organisms have a minimal effect on the incidence of intra-abdominal abscess formation.3 Bacteroides has been shown to be absent4 or, as. No extract is available for articles shorter than 400 words. © 1977, Massachusetts Medical Society. All rights reserved.
• Meislin, H. W., & Bremer, J. C. (1976). Jarisch-herxheimer reaction case report. Journal of the American College of Emergency Physicians, 5(Issue 10). doi:10.1016/s0361-1124(76)80309-7
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  The Jarisch-Herxheimer reaction is a response to the treatment of syphilis. The most common findings are fever, malaise, headache, and exacerbation of cutaneous lesions. The reaction is thought to be due to the effects of treponema breakdown products, and it should not be confused with an allergic reaction to the antibiotic employed. Thus, further therapy must not be withheld. Treatment is symptomatic. © 1976 American College of Emergency Physicians.
• Meislin, H. W., Rosen, P., & Sternbach, G. W. (1976). Life-support system: Emergency medical care for conventions. Journal of the American College of Emergency Physicians, 5(Issue 5). doi:10.1016/s0361-1124(76)80060-3
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  The life-support system described provides on-site emergency medical care for a designated group of people. It consists of a fixed subunit, a back-up emergency department; a temporary subunit, a life support station, and a mobile subunit, an ambulance and mobile medical personnel. A proposal for a life-support system for indoor conventions is presented with specifications of personnel, communications, supplies, registrant education and life-support team function. Results, critique, and discussion of a life-support station at the 1974 Annual ACEP/EDNA Scientific Assembly are presented. © 1976 American College of Emergency Physicians.
• Sternbach, G. L., Rosen, P., & Meislin, H. W. (1976). Extratemporal facial nerve injury. Journal of the American College of Emergency Physicians, 5(Issue 4). doi:10.1016/s0361-1124(76)80007-x
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  Isolated traumatic facial nerve injury, frequently seen in wartime combat, may also be encountered among civilians. The clinical picture occurring as a result of such injury may be confusing because partial, or incomplete, damage to the peripheral nerve may mimic impairment of the central facial motor mechanism. In treating the patient with facial injury, life-threatening aspects of the injury must be assessed and stabilized first. Then, attention may be focused on the injured facial nerve, for which prompt surgical repair is the treatment of choice. Prior to surgery, the assessment of taste and hearing, as well as mastoid and skull x-ray films and electrodiagnostic tests are helpful in localizing the facial nerve injury. © 1976 American College of Emergency Physicians.

Proceedings Publications

• Meislin, H. W. (2025, September).

  “Personal Protective Lightning Equipment (PPLE):                                                  9/25

  Preliminary Evaluation of a Wearable Garment to

  Prevent Lightning Induced Sudden Death”

  . In XVIII SIPDA International Symposium on Lightning Protection,.